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Hoarding Behaviour in the Elderly: Proposals for Better Elder Care


With Singapore experiencing an ageing population, the country has also recently faced a growing problem of elderly hoarding. In this article, Sng Hock Lin, Ph.D. student of Gerontology and Chief of ActiveSG, discusses the issue at its core along with the various ways we can tackle this problem. He also placed emphasis on the importance of leading an active lifestyle for older adults to age gracefully.

Identifying Hoarding Behavior in the Elderly and Building Rapport with Residents

What prompted this research project on elderly hoarders?

A: There has recently been an upward trend of elderly hoarders dying at home without anyone's knowledge. These incidents led me to reflect upon each person's role in society - to care for our fellow Singaporeans' physical and mental health - and what can be done to prevent similar incidents from happening in the future.

What are some of the challenges that you faced while conducting this research?

A: It was initially challenging to identify elderly hoarders, but with the help of some friends at Lions Befrienders, I managed to note some commonalities and telltale signs of this behaviour. Often, they would clutter their houses with an array of items. I would then compare this hoarding behavior against that of non-hoarders to obtain more information.

What are some key learning points that you gathered from your research?

A: Using qualitative research has allowed me to understand and focus on the reasons for their hoarding behavior instead of the gravity of it. For instance, there was a case of an elderly woman who hoarded many random things. This behavior stemmed from her financially deprived childhood - she was often envious of others who owned soft toys. As she matured, she began working in amusement parks to collect discarded carnival tokens in exchange for soft toys. Therefore, beneath their hoarding behaviour lies many stories and meanings to the hoarded items. Resultantly, elderly hoarders often derive a sense of security by hoarding things that have sentimental value. This explains the resistance they exhibit when they are asked to part with their items.

Understanding the Underlying Issues of Hoarding

Are the elderly at a greater risk of becoming hoarders?

A: Anyone can become a hoarder. The difference lies in one's ability to organise and retrieve the items. The elderly are at higher risk of becoming hoarders because of their reduced cognitive ability to sort their items. Perhaps the deeply-rooted virtue of thriftiness is a variable resulting in the development and escalation of hoarding behaviour. While this does affect their health, it can also indicate mental illness. Overall, hoarding is just a behavioural symptom underlying a plethora of issues. These social and psychological issues should also be considered within the realm of Social Sciences.

What are the social implications of this study?

A: As a result of comprehending the issues that contribute to their hoarding behaviour, I am more able to lobby on behalf of the elderly hoarders. After establishing rapport and a trusting relationship with them, I understand better the types of assistance they receive from various support systems, and am then able to advocate for necessary changes for them. This exemplifies SUSS's mission and vision of applying social sciences to the community. Also, by providing them with the support they require, they are more receptive to our help with clearing their things.

My research also hopes to inculcate social graciousness and kindness in communities. A commentary I wrote in 2019 was published in TODAY online[1] and attracted a positive reaction from Dr. William Wan, general secretary of the Singapore Kindness Movement, who stated that  "Interaction and emotional support are key to prevent vulnerable seniors from suffering depression."[2] Ultimately, change and the creation of an empathetic society takes time and everyone's collective effort.

Potential Partnership with Lions Befrienders and Support from the Community

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Are there other activities that you intend to implement to improve the social lives of the elderly?

A: On the ground, we at ActiveSG are working on a potential partnership with Lions Befrienders. We plan to introduce physical activities to isolated seniors, such as equipping the befrienders skills to engage seniors through sports and play. This will allow them to socialise and improve their overall well-being. Instead of looking at eliminating hoarding behaviour immediately, we need to address the basic concerns of the elderly. It is essential to provide them with social support and interaction. This will, in turn, help to reduce the potential of hoarding.

Why is it especially essential for the elderly to lead a healthy lifestyle?

A: Human muscle mass declines with age, so it is crucial to stay physically active to maintain strength, balance and flexibility. There are many ways to establish an active lifestyle, such as joining an interest group like water-based exercise or urban farming.

How do you think the community can support elderly hoarders?

A: Our community has already provided much assistance, such as food and transportation subsidies, and organising VWOs like the Lions Befrienders. However, during my visits, I noticed that the elderly hoarders receive an abundance of canned food and instant noodles especially during festive seasons. These are unhealthy food products for the aged. Therefore, it is pivotal that the community resources cater appropriately to the needs of the elderly. This requires a delicate balance as an oversupply of assistance can create an over-reliance on the community agencies. A lot has been done to help elderly hoarders. However, we can improve in terms of integrating the efforts.

Although groups such as community centres and grassroots organisations assist the elderly hoarders, Singapore's kampong spirit remains the key sustainable solution - keeping a lookout for our neighbours instead of judging their behaviour before understanding them.

Singaporeans should adopt a lifelong perspective since ageing is an inevitable process. We have a societal responsibility of giving back to the society, other than the different roles we have within our families and work environments. By giving back socially, we help build social capital among communities, hence providing social support for the elderly hoarders, who often face isolation.

Research on Caregivers to Persons with Dementia

Can you tell us more about your research on caregivers to persons with dementia?

A: I learned from my research that often, the caregiver and care system are separated when they are supposed to have a symbiotic relationship. The person with dementia might encounter two different environments daily - day activity centre and home. They could have slept in the day and then struggle to sleep at night, which brings massive stress to caregivers. However, beneath that, caregivers find strength in the meaning that they derive from caring for the person.

For instance, I encountered an interesting case. A lady had cared for her father-in-law for 10 years until his passing. Later, her mother-in-law, who had been unkind to her, developed dementia too. Upon asking her how she was able to carry on, she claimed that her determination to prove her mother-in-law wrong gave her the strength to do so.

Therefore, caregiving is a very complex yet interesting process. As I learn more about it, I begin to appreciate the different emotional and psychological stages throughout the care-giving journey. It is important to remember that the caregiver needs self-care to sustain their care of their loved ones.

Applying the Gerontological Perspective at ActiveSG

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How can the gerontological perspective benefit your work at ActiveSG?

A: Education and actual groundwork often appear as separate entities but I realise that I could apply what I learn and research to guide my work. For example, the interdisciplinary approach of SUSS Gerontology Programme taught me the importance of active ageing and the theory behind sustainable participation. I applied the gerontology knowledge to develop the active ageing master plan in collaboration with partners inclusive of schemes to encourage seniors to exercise such as the proposal on free entry to ActiveSG's gyms and pools for those aged 65 years old and above. To encourage volunteerism among older adults, we also proposed some incentive schemes.

 

Featured Commentaries by Hock Lin:

[1] Today (2019): Hoarders need emotional support. Here's how we can help them (https://www.todayonline.com/commentary/hoarders-need-emotional-help-heres-how-we-can-support-them)

Other references:

[2] Today (2019): With more seniors living alone, knowing and caring for our neighbours should be a norm(https://www.todayonline.com/voices/more-seniors-living-alone-knowing-and-caring-our-neighbours-should-be-norm)

The Centre for Applied Research conducted the interview with Hock Lin in July 2020.

For enquires about this article, please contact CFAR via email.

 

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